Making Meatloaf

Sharing information between medical professionals and patients and families is similar to sharing a meatloaf recipe. We can request the recipe from someone for their delicious meatloaf, but if they don’t share the recipe in detail, every detail that we need to know, we won’t get the same outcome.

If even one item or description is left out (how much bread crumbs, how large an onion or what cut of chopped meat), then the recipe will be incomplete and the outcome will be different.

The information being shared, and being heard, is filtered through 3 basic areas: Trust, Expertise, and Life Experience.

Trust is how much you can believe or count on someone. As the listener, you decide whether you can trust someone. Trust that the information is accurate. Trust that the information is complete. We even trust in ourselves that we have all the information we need without checking further.

Expertise is the knowledge that we each have about a particular subject. The listener may have expertise in an area so they do not pay close attention to the speaker. For example, an early childhood specialist may be a fine teacher but not know about childhood diseases.

Life experience focuses on your past experience. Have you been diagnosed with the flu in the past so now you may not listen carefully enough to what the doctor is saying to do for these symptoms? Or, perhaps the doctor treated a patient who has been noncompliant in the past, so now he spends less time with that patient.

By recognizing that we are filtering information constantly, we can avoid missing important information by being sure that what we say is being heard accurately. We can ask the doctor to repeat back what he heard us say. And we can repeat back what the doctor said to us.

A medical professional can easily miss a diagnosis if we forget to share all important information. The healthcare professional should repeat back the symptoms we have told them. The same goes for what we have heard them explain.

What time of day to take the medication and how many pills need to be taken at once can mean the difference between a positive outcome and one that has disastrous results.

So next time you get information from the medical professional treating you, or whether you are sharing a meatloaf recipe, be sure to repeat back what you “think” you heard so the outcome is what you want.

Working on my fellowship for the American Hospital Association and National Patient Safety Foundation Patient Safety Leadership program I have been given opportunities to read some of the very interesting information about patient safety I would have otherwise passed over. I am reminded about the history and the studies that have been done over the years. Patient safety is a topic so near and dear to my heart. I am one of the very few people lucky enough to turn a “hobby” into a career. Of course the pay sucks but the work is very fulfilling.

Reading articles written about making a business case for patient safety is a reminder how bad the problems really are in healthcare. If information has been studied, measured and implemented in one facility, why aren’t other medical institutions following this same process? If it works in one facility, why aren’t they all doing it?

Maybe because they haven’t read the same articles I am reading. They have to find this information out for themselves instead of some organization saying “here’s the way it should be done”.

Hopefully now with the Joint Commission’s new Center for Transforming Healthcare we will start to see how best practices can be learned and followed.

There are 2 very important roles to being a useful and productive patient (safety) advocate. One is being objective and one is being a good communicator.

Being objective means that you allow someone to make their own decisions. Words like “you have to” or “you need to” does not make for an objective participant. Words to get the same results can be “have you thought of….” By telling someone what they “have” to do takes the power away from them. Telling someone what to do can also cause push back from the listener. The first thing I think of is “no, I don’t have to”.

As an advocate, we want the patient (or even the patient’s family) in control. We want them to make decisions but have all available resources.

As a good communicator, it may mean not talking and just listening for long periods of time. No one cares about your broken foot or gall bladder operation. It’s not about you. Practice not talking for a while. Don’t ask questions or change the subject. Just listen. Search for the feelings of the patient. Are they scared, confused or angry? Acknowledge these feelings and don’t run away from them.

Allowing patient’s to share their feelings and not bury them can help them move on and concentrate on other issues. Storing their feelings of anger for being injured, or scared about their recent diagnosis blocks them from hearing important information or from recognizing other things around them that they need to know.

I have to admit, it is exciting to be chosen to Modern Healthcares Top 100 Most Powerful People in Healthcare but I’m not sure what the responsibility means.

First, you should know that I am a big fan of Modern Healthcare. The writers of this weekly magazine actually call for my opinion and return calls if I reach out to them. Unlike less popular and “snooty” papers, there seems to be real people working there with manners and courtesy to their readers. I am impressed with any professional writer who asks my opinion because I have not been trained in “political correctness” and very often state my opinion on a topic that may not be what the paper, nor their readers want to read.

I have quoted Modern Healthcare on occasion to my colleagues because I do believe they do their homework. When the information I am sharing about an article I read is not satisfactory to the person I am speaking to, they have gone so far to say that the magazine is not worthy of their time. On the other hand, they too read the magazine and at times been featured in it.

I remember saying to the CEO of a very popular hospital, at a meeting that I was surprised his hospital was not listed in a top hospitals article in Modern Healthcare. He asked to see the paper and after reading it, mumbled something about the magazine being garbage. One of his colleagues asked me what I did to get him so angry. I assume if his hospitals were listed, the magazine would have been a treasure.

This year, Modern Healthcare writes that there were 25,700 names submitted to be the Top 100 Most Powerful People in Healthcare. Nearly 52,000 people voted on the top choices. Out of those 25,700 names there are probably 25,600 who think Modern Healthcare is “garbage”. Probably, many the same people who thought it was a treasure last year when they were featured .

What now? Will being in the list of Top anything help our cause? Will people listen? Will we really be able to change things or make the world a better place because we are listed in the top 100 of anything?

As the president of a grassroots patient safety organization, my roll is, in part to get publicity for the organization and our cause. This is rarely done. PULSE of NY does almost no advertising because of our size and small budget. For that alone, being featured in Modern Healthcare is wonderful . The many letters and e-mails of support I received, many labeled #76!, helped me hear from people I have not heard from in years.

Although I am sure this list won’t suddenly make the world better and may not even open doors, it surely couldn’t hurt. I am grateful for those who voted for me and Modern Healthcare for holding this contest (until, of course I am off the list)

The situation in a hospital is not that a patient should never be left alone, but that the patient’s family should not have to be alone either to deal with the emotional stresses of having a family member hospitalized for a serious, or even a non-serious ailment.

I wouldn’t say there should be a third party around the bed 24/7. That’s just not realistic. I am saying an “advocate” available to the family, not affiliated with the health system is needed. That’s where I come in.

Recently I went to visit a 97 year old woman in a rehab center / nursing home. Her mind is as sharp as someone half her age but she is in rehab following a fall at home.

Her grandson told me her call bell was not working. He has asked for it to be fixed on numerous occasions and each time a report is filed, someone comes in and changes the cord, it works and they leave. Immediately following the “repair” it doesn’t work again.

A 97 year old woman who is considered a fall risk needs a call bell. This is a serious safety issue – period.

Unfortunately this lovely woman soiled herself during the night when no one was answering her call bell, that didn’t work. This angered the family, no doubt, even more.

By the time I arrived, the call bell was changed about 3 times. The family was angry, or so they should be, we now had a dangerous situation; Grandma could easily get up and fall.

When I went to the nurse’s station to report this hazard, I was told that a report will be filed. I wanted to see someone in charge. Soon I was face to face with the person in charge of maintenance. Together we went to grandma’s room and the box was pulled out and replaced. It was a short in the box in the wall. Obvious even to me.

Why did it come to anger and danger when it could have easily been looked at as a problem after the first time the call bell stopped working again? The nurse in charge would have allowed it to continue were I not insistent that someone in charge get involved.

What is also troubling is that the "Director of Plant Engineering', the gentleman who accompanied me to the room, did not know about the numerous complaints. He thought he was not responsible because he didn’t know – but why didn’t he know? What is the communication breakdown that allowed this to go on for so long?

According to the Agency for Healthcare Research and Quality, falls account for 70% of hospital accidents. Effective October 1, 2008, Medicare and many state Medicaid agencies no longer reimburse hospitals for costs associated with treating injuries incurred by patients who fall while hospitalized.

A study of people age 72 and older, the average health care cost of a fall injury totals $19,440.00 according to the Center for Disease Control and Prevention (CDC).

It is therefore my opinion, we may have saved this facility almost $20,000.00. Something to consider when they say they have no funding.

I’m finishing up my last minute packing for my business trip to Hawaii. Before you think Oh boy, she’s got the life, let me remind you I added the word “business” in the last sentence purposely. I do not get pleasure, nor do I seek pleasure in my business trips. You may think that I should, but you are entitled to think what you want. Very few people understand why I feel this way.

I remember years ago I was invited to go to a beautiful Caribbean island to speak in front of a group of pharmacists. I had to get my passport. The planning was longer than I would have liked and the flight (although not nearly as long as Hawaii) was also longer than I would have liked. It was a constant reminder that this is not what I would have planned for vacation. Still you might think - enjoy it while you're there.

During that trip years ago I flew in and arrived at 7:00 pm, enough time for a networking dinner and by 11:00 am I was on my way back to the airport. I love the Caribbean water but never went near it even though it was only yards away. To dip my feet into the beautiful water, or sit on this beautiful sand, would be, for me, a disloyalty to all the patients and family’s I am doing this for. How can I enjoy the ocean, a sunset or the sand when the reason I am there is because people are dying every day from preventable medical errors?

It may be a form of post traumatic stress that is just now becoming recognized following a medical injury. I live with the death of my son daily not just because I do - but because I have chosen, and been given the opportunity to share his story and other stories so I can help make a better and safer health care system.

It could be that I am just a loyal person to this cause or, it could be that I just don’t know how to have a good time and “lighten up” as some folks have told me. But it is very personal, and very important to me, as an individual, that I remember why I was given this opportunity to travel the country and share the tragic stories of those who passed on, or suffer today because of medical injuries. It is not to swimming, sunbathing or having fun – although this time I did pack a bathing suit.

I spoke to Patty yesterday (names are changed). We spoke a few years ago and then lost contact. Her story stayed with me over the years because it is sad and painful but so real.

Her husband was seriously damaged during surgery. He was a businessman she, a businesswoman. They had careers, a home and close family. Following his injury, she became his caretaker and he lost his job, she could barely work and they became poor and lost their home.

When I speak to her, she could be anyone of my friends or family members. Patty is educated and articulate – but she is one of those in the “system” that has failed us as patients.

She waited too long to sue. Her husband’s injury and caring for him consumed her. They expected honest answers from the doctors and hospital. Her husband worked for the hospital. He ran a department. The hospital denied any wrongdoing but still, he went in for treatment and came back an invalid, unable to care for himself, in a variety of ways.

Patty is still angry and feels obsessed with telling her story. But, all too often no one wants to hear it. How can she sound reasonable with all this anger and grief? Now Patty tells me she fears she will die before her husband; no one to care for him and no one to tell his story. Her health is failing and she has years of research and documentation of her husbands care and treatment and why it was inappropriate. She wants to know what she should do with it.

I hear stories like this and feel like a failure myself. How can I help her or others like her? I probably can’t. Can I help others never to be in this situation to begin with? I just don’t know. Do I want to be in the center of the pain and turmoil Patty feels? Yes, I do because it is the reason I continue this work.

I sometimes wonder where I can go with this but hopefully someone will read this with ideas. There are just too many Patty’s out there.

12 in a Room……..

What do you get when you put 12 strangers in a room for a week, from each part of the country, (and Canada) with different backgrounds, different educations, different lifestyles but one passion – to make healthcare safer? You will probably get - safer healthcare.

This has been my experience this past week in California as I begin my year long journey as a Patient Safety Leadership Fellow at the American Hospital Association and National Patient Safety Foundation training. Using our own project to make patient care safer as an anchor for our work, we spent 4 ½ days bonding as we learned about “Gracious Space” which focuses on sharing information and accepting other's differences. We did team building that made us laugh but also recognize our own leadership skills and lack of them and we learned about each other, and how each of us are interested, in our own way, in making patient care safer which will not only improve care – but save lives.

It was an eye opening experience and the people who I have grown to adore in just a few days are all so different I have to wonder if this was planned. 11 women and a young male doctor who many of us began (s)mothering almost immediately. One Fellow with a contagious sense of humor, another with an infectious laugh and smile, another with a more serious side that is built upon years seeing the worst in healthcare. One who seems a natural mom and caretaker and another who is quiet but has an obvious charm and gentleness.

These personalities are as different as their (our) work and projects. In the year to come, we will each touch our community or healthcare system and begin to focus on the missing piece we each see as a need for our intervention in patient’s safety.

I look forward even more now to the upcoming year, though I don’t see it an easy year following our first in person meeting. I know it will be a difficult time but am committed that through this fellowship, I will make healthcare safer here at least on Long Island – if I have anything to say about it – and now I do.

Here it is again – July. According to the best selling book “You the Smart Patient” by Michael F. Roizen MD and Mehemet C. Oz, best known for his appearances on Oprah, midsummer is the worst time to check into a hospital. July is when hospitals are “crawling with newbies” and the least experienced physicians. We should “give them a few months to break in” the book tells us. Gee, thanks for the warning us (on page 33 last paragraph)

Any wonder we celebrate Patient Safety Day in July? July 25th patient safety advocates throughout the country and around the world are connected by a few moments of silence at 6:00 PM. We remember those who have lost their life because of their medical care or their life has been changed forever – the survivors as I like to call them.

Although I don’t want to fear for those poor souls who must use the hospital system in July and August, I do know of many deaths which resulted in medical injury. I am saddened each year around this time even though it doesn’t coincide with my own, personal loss. Unfortunately, there seems to be very little we can do about this except be sure the patients, or potential patients know about this dangerous time to be hospitalized.

I am often saddened by the knowledge that is not being shared that people are more likely to be injured or killed in July. (Not my information, read my friend and colleagues blog) Patient Empowerment Blog . You can’t make this stuff up.

Seems simple enough to fix – no? Last year we held an emotionally charged event on Patient Safety Day; A tribute to the lives lost and changed forever. This year I will be heading back from California on July 25th where I start my patient safety fellowship. But you can rest assured I will be thinking, at 6:00 PM about those who could not be with us today.

I recently received these wonderful photos of the “Fountain” at the National Patient Safety Foundation Annual Congress. It may, at first just look like a fountain but it is much more. It is a place that people who have suffered the loss of a family member, friend or a patient from a medical injury can put a flower in and spend time reflecting, hoping and wishing for the things that bring us all together – patient’s safety.

Anyone can come buy and put a flower in the fountain representing the loss of life or quality of life because of medical care.

The fountain won’t be found at other conferences but NPSF continually remembers the patients and hears the patient’s voice through their work.

The fountain is one of those things that makes NPSF special and makes them different than other organizations. It’s not inexpensive and doesn’t add to the educational aspect of the yearly congress but it surely does add to the humanness of patient safety and the reason we all do this work.